Dementia and driving

Keeping older drivers safe on the road

Does a diagnosis of dementia automatically mean the car keys should be taken away? Opinions, rules and practices vary across the country, but a group of Canadian researchers hopes to fix this.

They’re creating guidelines and tools to help family doctors assess their older patients’ fitness to drive, including their cognitive abilities. A recent Queen’s University study predicts Ontario drivers with dementia will more than double to 100,000 in 2028. The need for science-based guidelines is urgent says Dr. Mark Rapoport, a geriatric neuropsychiatrist at Sunnybrook Health Sciences Centre in Toronto.

Family doctors must report patients who may be unfit to drive to the Ontario Ministry of Transportation. But Dr. Rapoport says family doctors often don’t have the training to make that assessment, and many are reluctant to take away their patients’ independence along with their licence.

That’s where the Canadian Driving Research Initiative for Vehicular Safety in the Elderly (CanDRIVE) comes in. The program’s nearly 100 researchers – including Dr. Rapoport – recruited 1,000 drivers aged 70 and older to take part in a Canada-wide study of the factors affecting their safety on the road. Volunteers have agreed to have a transmitter in their cars to record events such as sudden stops and accidents.

The five-year research initiative, now in its third year, is also examining the effectiveness of road tests for seniors, automobile design and what makes seniors decide to stop driving.

Shades of grey

In addition to working on the main study, Dr. Rapoport is compiling case studies to help guide family doctors. He recruited 20 medical experts in dementia and gave them 26 “grey area” cases, or fictitious patients with early-stage dementia. Dr. Rapoport has asked each of his medical experts to determine whether they would report the patient and why, insight he plans to share with family doctors.

“In the early stages (of dementia) some people may be able to drive and the main message of CanDRIVE is to keep safe older drivers driving and get unsafe drivers off the roads,” says Rapoport, whose research is partially funded by the Alzheimer Society Research Program.

Certainly Ontario’s Ministry of Transportation understands what’s at stake. In February, Minister Bob Chiarelli announced that his department is looking into new rules for drivers with dementia.

The move is expected to include better training for family doctors, tougher road tests for seniors and “de-graduated” licences for those who may be uncomfortable driving at night or on highways.

An April editorial in the Canadian Medical Association Journal also supports a move toward de-graduated licences. Though some seniors remain excellent drivers, the editorial also points out that “of the 2209 Canadians who died in motor vehicle accidents in 2009, 389 were over age 65, a higher incidence than any other age group and far higher than those half their age.”

Alternative transportation

But just as pressing as the need for developing new rules for drivers with dementia is the dilemma over how to support seniors once they can no longer drive, something CanDRIVE researchers are also investigating.

“My rural colleagues are most concerned about this,” says Rapoport. “You can’t get groceries delivered in some northern parts of Ontario. You can’t get basic necessities. People have to move into nursing homes as a consequence of not being able to drive.”

Even in urban areas where there are more transportation options, seniors without licences are often reluctant to take public transit because they can be frail and find the bustling environment difficult. For others, it’s confusing, especially if they have always driven. And taxis are simply too expensive.

“How do we get them transportation? That’s the key thing,” says Dr. Rapoport. “How are they going to continue to live their lives outside the four walls of their home?”

All physicians are legally responsible to report patients who have medical conditions that may affect their driving. Driver test and licensing rules, however, vary by province. It is best to check with your provincial Ministry of Transportation for current rules.